[Congressional Record Volume 146, Number 74 (Wednesday, June 14, 2000)]
[Senate]
[Pages S5109-S5113]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KENNEDY (for himself, Mr. Bryan, Ms. Mikulski, and Mr. 
        Wellstone):
  S. 2727. A bill to improve the health of older Americans and persons 
with disabilities, and for other purposes; to the Committee on Finance.


                medicare health improvement act of 2000

  Mr. KENNEDY. Mr. President, today we are introducing legislation to 
improve the health of Medicare beneficiaries and the health of the 
Medicare program itself. Under Medicare, the health and quality of life 
for millions of older adults and people with disabilities have 
significantly improved. The rate of chronic disability among adults 
over 65 continues to decline, but we can do better. A recent report by 
the World Health Organization showed that the U.S. falls behind 23 
other nations in ``healthy life expectancy.'' On average, Americans can 
expect only 70 healthy years, compared to Japanese citizens who can 
anticipate 74\1/2\ years of life without disability. Chronic disability 
robs too many older Americans of active and productive years, and adds 
$26 billion annually in health care costs as people over 65 lose their 
ability to live independently.
  In the next 30 years, the viability of Medicare will be challenged as 
the baby boom generation ages. Nearly one fifth of the population will 
be 65 and older by 2025, which means that a larger number of 
beneficiaries will be supported by a smaller number of workers. The 
current debate over the future of Medicare often revolves around 
benefit cuts or tax increases. But an obvious alternative that should 
be part of the debate is to reduce the demand for Medicare by improving 
the health of senior citizens. Unfortunately, Medicare today contains 
few incentives to encourage beneficiaries and providers to take health 
promotion and disease prevention seriously. This bill will help older 
adults and individuals with disabilities to improve their health. It 
will also educate health providers about the best practices for 
treatment of Medicare patients.
  Older adults are generally health conscious and are interested in 
taking steps to maintain their health and independence. Poor lifestyle 
factors--which include lack of exercise, poor diet, at-risk behaviors, 
smoking, and alcohol abuse--account for 70% of the physical decline and 
disease that occur with aging. Experts agree that the potential for 
better health through health promotion and disease prevention is great. 
Too often, however, older Americans lack the accurate information that 
would help them take advantage of these opportunities. This bill will 
ensure that Medicare beneficiaries are better informed about the 
lifestyle changes they can make to improve their health, and the 
preventive health services they can use to prevent disease.
  To encourage more beneficiaries to use the preventive services that 
Medicare currently offers, our legislation will eliminate cost-sharing 
for these services. Prevention saves lives and saves money. The 
incidence of cancer in adults over 65 is approximately eleven times 
higher than in persons under 65. Most cancers can be treated and many 
can be cured if detected early. But cancer screening tests are 
significantly underused by Medicare beneficiaries. Thirty-eight percent 
of women over 65 who have survived breast cancer (and remain at risk) 
do not receive an annual mammogram. Our bill will waive cost-sharing 
for mammography, screening pelvic exams, colorectal cancer screening, 
prostate cancer screening, bone mass measurement, hepatitis B vaccine 
and its administration, and diabetes self-management training.

  Despite the great potential of preventive services to improve the 
quality of life for older Americans, few clinical guidelines focus on 
preventive care for this population. Our bill calls for a task force to 
conduct studies to determine which preventive services in primary care 
are most valuable to senior citizens. A separate demonstration project 
will determine effective means to reduce smoking by Medicare 
beneficiaries. Cessation of smoking can reduce the risk of lung cancer, 
heart disease, and stroke. In 1997, smoking-related expenditures were 
estimated to cost the Medicare program a total of $20.5 billion.
  There are substantial defects in the quality of care provided to 
Medicare beneficiaries. Medical research has established that early use 
of a beta blocker after a heart attack reduces the risk of mortality 
and rehospitalization. Yet 51 percent of older adults fail to receive 
this treatment when it is indicated. In fact, patients at the highest 
risk of death in the hospital are least likely to receive a beta 
blocker.
  Every senior citizen deserves quality health care. The gaps between 
the best medical practice and actual practice must be narrowed. Our 
bill asks the Department of Health and Human Services to determine 
which areas in the treatment of Medicare beneficiaries do not meet the 
highest professional standards, and to determine the best practices in 
those areas. Steps will then be taken to inform health care 
professionals about these standards for treatment.
  The opportunities for better health care and budget savings are 
great, if care can be delivered to beneficiaries with high-cost chronic 
conditions in a more coordinated and effective way. Our legislation 
authorizes demonstration projects to develop innovative approaches to 
increase the quality of care and reduce costs for Medicare 
beneficiaries in skilled nursing facilities. Similar demonstration 
projects are authorized for beneficiaries with serious or chronic 
illness who do not reside in nursing facilities.
  In ways like this, we do more--much more--to preserve and strengthen 
Medicare, and achieve substantial long-term savings as well. I look 
forward to working closely with my colleagues on both sides of the 
aisle to achieve this important goal. I ask unanimous consent that the 
bill, the bill summary, and the relevant fact sheet be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2727

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Health Improvement Act of 2000''.
       (b) Table of Contents.--The table of contents is as 
     follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.

                    TITLE I--HCFA MISSION STATEMENT

Sec. 101. Establishment of HCFA mission statement with regard to the 
              medicare program.

  TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO 
                      IMPROVE THEIR HEALTH STATUS

Sec. 201. Waiver of all preventive services cost sharing under the 
              medicare program.
Sec. 202. Information campaign on preventive health care for older 
              Americans and individuals with disabilities.
Sec. 203. Development of health status self-assessment tool for 
              medicare beneficiaries.

 TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS 
                     AND PERSONS WITH DISABILITIES

Sec. 301. Information campaign for the best practices for the treatment 
              of conditions of medicare beneficiaries.
Sec. 302. Program to promote the use of best practices for the 
              treatment of conditions of medicare beneficiaries and to 
              reduce hospital and physician visits that result from 
              improper drug use.
Sec. 303. Studies on preventive interventions in primary care for older 
              Americans.
Sec. 304. Smoking cessation demonstration project.

[[Page S5110]]

 TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF 
     SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES

Sec. 401. Demonstration projects to provide effective care for skilled 
              nursing facility residents.
Sec. 402. Demonstration projects to improve the care of persons with 
              serious illnesses.

   TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER 
                               AMERICANS

Sec. 501. White House Conference on Improving the Health of Older 
              Americans.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) Commissioner.--The term ``Commissioner' means the 
     Commissioner of Social Security.
       (2) Medicare beneficiaries.--The term ``medicare 
     beneficiaries'' means individuals who are entitled to 
     benefits under part A or enrolled under part B of the 
     medicare program, including individuals enrolled in a 
     Medicare+Choice plan offered by a Medicare+Choice 
     organization under part C of such program.
       (3) Medicare program.--The term ``medicare program'' means 
     the health insurance program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

                    TITLE I--HCFA MISSION STATEMENT

     SEC. 101. ESTABLISHMENT OF HCFA MISSION STATEMENT WITH REGARD 
                   TO THE MEDICARE PROGRAM.

       Part A of title XVIII of the Social Security Act (42 U.S.C. 
     1395 et seq.) is amended by inserting before section 1801 the 
     following:


                        ``HCFA MISSION STATEMENT

       ``Sec. 1800. In administering the health insurance program 
     established under this title, it is the mission of the Health 
     Care Financing Administration to--
       ``(1) effectively and efficiently administer a program of 
     health insurance coverage for individuals who are entitled to 
     benefits under part A or enrolled under part B of this title, 
     including individuals enrolled in a Medicare+Choice plan 
     offered by a Medicare+Choice organization under part C of 
     this title, in accordance with the requirements of this 
     title;
       ``(2) assure that health care provided to such individuals 
     is of the highest quality; and
       ``(3) carry out programs in cooperation with other 
     Government agencies and the private sector to promote health, 
     prevent disease, and assure the highest possible functional 
     level for such individuals.''.

  TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO 
                      IMPROVE THEIR HEALTH STATUS

     SEC. 201. WAIVER OF ALL PREVENTIVE SERVICES COST SHARING 
                   UNDER THE MEDICARE PROGRAM.

       (a) Waiver of Coinsurance and Deductibles.--
       (1) In general.--Section 1834 of the Social Security Act 
     (42 U.S.C. 1395m) is amended by adding at the end the 
     following:
       ``(m) Waiver of Coinsurance and Deductible for Preventive 
     Services.--
       ``(1) Coinsurance.--
       ``(A) In general.--Notwithstanding any other provision of 
     this part--
       ``(i) the Secretary shall waive any coinsurance applicable 
     to services described in subparagraph (B); and
       ``(ii) with respect to payment for such services, any 
     reference to a percent that is less than 100 percent shall be 
     deemed to be a reference to 100 percent.
       ``(B) Services described.--The services described in this 
     subparagraph are the following services:
       ``(i) Screening mammography (as defined in section 
     1861(jj)).
       ``(ii) Screening pelvic exam (as defined in section 
     1861(nn)(2)).
       ``(iii) Hepatitis B vaccine and its administration (under 
     section 1861(s)(10)(B)).
       ``(iv) Colorectal cancer screening test (as defined in 
     section 1861(pp)).
       ``(v) Bone mass measurement (as defined in section 
     1861(rr)).
       ``(vi) Prostate cancer screening test (as defined in 
     section 1861(oo)).
       ``(vii) Diabetes outpatient self-management training 
     services (as defined in section 1861(qq)).
       ``(2) Deductible.--
       ``(A) In general.--Notwithstanding any other provision of 
     this part, the deductible described in section 1833(b) shall 
     not apply with respect to services described in subparagraph 
     (B).
       ``(B) Services described.--The services described in this 
     subparagraph are the following services:
       ``(i) Hepatitis B vaccine and its administration (under 
     section 1861(s)(10)(B)).
       ``(ii) Colorectal cancer screening test (as defined in 
     section 1861(pp)).
       ``(iii) Bone mass measurement (as defined in section 
     1861(rr)).
       ``(iv) Prostate cancer screening test (as defined in 
     section 1861(oo)).
       ``(v) Diabetes outpatient self-management training services 
     (as defined in section 1861(qq)).''.
       (2) Conforming amendment.--Section 1833(a) of the Social 
     Security Act (42 U.S.C. 1395l(a)) is amended by striking 
     ``section 1876'' and inserting ``sections 1834 and 1876'' in 
     the matter preceding paragraph (1).
       (b) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after December 31, 
     2001.

     SEC. 202. INFORMATION CAMPAIGN ON PREVENTIVE HEALTH CARE FOR 
                   OLDER AMERICANS AND INDIVIDUALS WITH 
                   DISABILITIES.

       (a) In General.--The Secretary and the Commissioner shall 
     jointly conduct an information campaign, in consultation with 
     the heads of other Government agencies and States and the 
     private sector, for individuals who have attained age 50 and 
     individuals with disabilities to promote--
       (1) the use of preventive health services among such 
     individuals, including services that are available to 
     medicare beneficiaries and are covered by the medicare 
     program;
       (2) the proper use of prescription and over-the-counter 
     drugs in order to reduce the number of hospital stays and 
     physician visits among such individuals that are a result of 
     the improper use of such drugs; and
       (3) the steps (including exercise, maintenance of a proper 
     diet, and utilization of accident prevention techniques) that 
     such individuals may take in order to promote and safeguard 
     their health.
       (b) Use of Services.--The information campaign described in 
     subsection (a) shall stress the benefits of--
       (1) using the services described in subsection (a)(1);
       (2) following the proper directions for using prescription 
     and over-the-counter drugs as described in subsection (a)(2); 
     and
       (3) utilizing the steps described in subsection (a)(3).
       (c) Elements of Campaign.--In conducting the information 
     campaign described in subsection (a), the Secretary and the 
     Commissioner (as applicable) shall--
       (1) expand the section in the Medicare and You handbook on 
     preventive benefits to include a more detailed description of 
     the importance of using preventive health services and the 
     benefits offered under the medicare program;
       (2) instruct fiscal intermediaries and carriers under the 
     medicare program to include preventive benefits messages on 
     the Medicare Summary Notice statement and the Explanation of 
     Medicare Benefits;
       (3) regularly include preventive benefits messages on the 
     medicare part B benefits statement;
       (4) combine public service announcements and a print media 
     campaign to raise awareness of the value of using preventive 
     health services;
       (5) distribute brochures and other information on health 
     promotion and disease prevention activities through--
       (A) State health insurance assistance programs;
       (B) area agencies on aging;
       (C) Social Security Administration field offices; and
       (D) any other appropriate entities, as determined by the 
     Secretary and the Commissioner; and
       (6) include information on the importance of using 
     preventive health services--
       (A) on the cost of living adjustment (COLA) notice, which 
     is sent to individuals who receive disability benefits under 
     titles II and XVI of the Social Security Act (42 U.S.C. 401 
     et seq.; 1381 et seq.);
       (B) on the social security account statements distributed 
     pursuant to section 1143 of the Social Security Act (42 
     U.S.C. 1320b-13); and
       (C) in brochures on retirement and survivors' benefits that 
     are produced by the Commissioner.
       (d) Targeted Populations.--To the extent appropriate, 
     aspects of the information campaign described in subsection 
     (a) may be targeted to specific subpopulations of medicare 
     beneficiaries.
       (e) Grants and Contracts.--
       (1) In general.--The Secretary and the Commissioner shall 
     provide grants to, and enter into contracts with, eligible 
     entities to assist with carrying out the purposes of this 
     section.
       (2) Eligible entity defined.--In this subsection, the term 
     ``eligible entity'' means--
       (A) any community organization working with medicare 
     beneficiaries;
       (B) any organization representing medicare beneficiaries;
       (C) area agencies on aging; and
       (D) any other appropriate entities, as determined by the 
     Secretary and the Commissioner.

     SEC. 203. DEVELOPMENT OF HEALTH STATUS SELF-ASSESSMENT TOOL 
                   FOR MEDICARE BENEFICIARIES.

       (a) Development.--The Secretary, in conjunction with the 
     Director of the National Institutes of Health, the Director 
     of the Centers for Disease Control and Prevention (CDC), the 
     Administrator of the Substance Abuse and Mental Health 
     Services Administration (SAMHSA), and the Administrator of 
     the Agency for Healthcare Research and Quality (AHRQ), shall 
     develop a health status self-assessment tool that includes 
     assessment of mental health status, alcohol use, and 
     substance use, and assists medicare beneficiaries in 
     identifying important health information, risk factors, or 
     significant symptoms that should be acted upon or discussed 
     with the beneficiary's health care provider.
       (b) Distribution.--The Secretary shall establish procedures 
     for the distribution of the self-assessment form developed 
     under subsection (a) and may contract with the eligible 
     entities described in section 202(e)(2) to distribute and 
     promote the use of such forms.

[[Page S5111]]

       (c) Training.--The Secretary shall establish a training 
     program for the staff of State health insurance assistance 
     programs that will enable such staff to assist medicare 
     beneficiaries in completing the self-assessment form 
     developed under subsection (a).

 TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS 
                     AND PERSONS WITH DISABILITIES

     SEC. 301. INFORMATION CAMPAIGN FOR THE BEST PRACTICES FOR THE 
                   TREATMENT OF CONDITIONS OF MEDICARE 
                   BENEFICIARIES.

       (a) Study.--The Secretary, in consultation with the 
     Administrator for Health Care Policy and Research, the 
     Director of the National Institutes of Health, and such other 
     professional societies and experts as the Secretary considers 
     appropriate, shall--
       (1) conduct a study to determine areas where treatment of 
     medicare beneficiaries falls short of the highest 
     professional standards; and
       (2) determine the best practices in the areas described in 
     paragraph (1).
       (b) Information Campaign.--The Secretary shall provide for 
     an information campaign to inform medicare beneficiaries 
     about the results of the study conducted under subsection 
     (a).

     SEC. 302. PROGRAM TO PROMOTE THE USE OF BEST PRACTICES FOR 
                   THE TREATMENT OF CONDITIONS OF MEDICARE 
                   BENEFICIARIES AND TO REDUCE HOSPITAL AND 
                   PHYSICIAN VISITS THAT RESULT FROM IMPROPER DRUG 
                   USE.

       (a) In General.--The Secretary, in conjunction with the 
     Administrator of the Health Resources and Service 
     Administration and such other agencies and professional 
     societies as the Secretary deems appropriate, shall establish 
     a program to--
       (1) improve treatment of medicare beneficiaries based on 
     the results of the study conducted under section 301(a) and 
     other relevant information; and
       (2) reduce the number of hospital stays and physician 
     visits among medicare beneficiaries that are a result of the 
     improper use of prescription and over-the-counter drugs.
       (b) Elements of Program.--The program described in 
     subsection (a) shall include--
       (1) an information campaign for health professionals;
       (2) coordination of the part of the program established 
     under subsection (a) that is designed to achieve the purpose 
     described in paragraph (2) of that subsection with the 
     information campaign conducted under section 202; and
       (3) any other activity the Secretary considers appropriate 
     to carry out the purposes described in subsection (a).
       (c) Demonstrations and Grants.--In establishing the program 
     under subsection (a), the Secretary may conduct demonstration 
     projects and award grants to eligible entities (as defined in 
     subsection (d)).
       (d) Eligible Entity Defined.--In this section, the term 
     ``eligible entity'' means an entity that is an academic 
     health center, a professional medical society, or such other 
     entity as the Secretary considers appropriate to carry out 
     the purposes of this section.
       (e) Report to Congress.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter, the 
     Secretary shall annually report to Congress on the program 
     conducted under this section.

     SEC. 303. STUDIES ON PREVENTIVE INTERVENTIONS IN PRIMARY CARE 
                   FOR OLDER AMERICANS.

       (a) Studies.--The Secretary, acting through the United 
     States Preventive Services Task Force, shall conduct a series 
     of studies designed to identify preventive interventions that 
     can be delivered in the primary care setting that are most 
     valuable to older Americans.
       (b) Mission Statement.--The mission statement of the United 
     States Preventive Services Task Force is amended to include 
     the evaluation of services that are of particular relevance 
     to older Americans.
       (c) Report.--Not later than 1 year after the date of 
     enactment of this Act, and annually thereafter, the Secretary 
     shall submit a report to Congress on the conclusions of the 
     studies conducted under subsection (a), together with 
     recommendations for such legislation and administrative 
     actions as the Secretary considers appropriate.

     SEC. 304. SMOKING CESSATION DEMONSTRATION PROJECT.

       (a) In General.--The Secretary, acting through the 
     Administrator of the Health Care Financing Administration, 
     shall conduct a demonstration project to--
       (1) evaluate the most successful and cost-effective means 
     of providing smoking cessation services to medicare 
     beneficiaries; and
       (2) test incentive systems for physicians, other health 
     care professionals, and medicare beneficiaries to optimize 
     rates of successful smoking cessation among medicare 
     beneficiaries.
       (b) Latest Scientific Evidence.--The Secretary shall use 
     the latest scientific evidence regarding smoking cessation 
     strategies and guidelines in conducting the demonstration 
     project under this section.
       (c) Payment.--Payment to an individual or an entity for a 
     service provided under the demonstration project shall be 
     equal to the lesser of--
       (1) the actual charge for providing the service to a 
     medicare beneficiary; or
       (2) the amount determined by a fee schedule established by 
     the Secretary for the purposes of this section for such 
     service.
       (d) Waiver Authority.--
       (1) In general.--The Secretary may waive such requirements 
     of the medicare program as may be necessary for the purposes 
     of carrying out the demonstration project conducted under 
     this section.
       (2) Non-medicare providers.--Individuals and entities that 
     do not provide items and services under the medicare program 
     shall be permitted to participate in the demonstration 
     project conducted under this section.
       (e)  Report to Congress.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter, the 
     Secretary shall report to Congress on the demonstration 
     project conducted under this section.

 TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF 
     SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES

     SEC. 401. DEMONSTRATION PROJECTS TO PROVIDE EFFECTIVE CARE 
                   FOR SKILLED NURSING FACILITY RESIDENTS.

       (a) In General.--The Secretary shall conduct demonstration 
     projects that are designed to provide medicare beneficiaries 
     who are residents of skilled nursing facilities (as defined 
     in section 1819(a) of the Social Security Act (42 U.S.C. 
     1395i-3(a)) with higher quality and more cost-effective 
     services in order to avoid unnecessary hospitalizations of 
     such residents.
       (b) Requirements.--
       (1) In general.--The demonstration projects conducted under 
     this section shall include the following:
       (A) Programs of case management.
       (B) Programs of disease management.
       (C) Such other programs as the Secretary determines are 
     likely to increase the quality of, and reduce the cost of, 
     the care provided to such residents.
       (2) Authorized techniques.--The demonstration projects 
     conducted under this section may utilize--
       (A) contracts with centers of excellence or other entities 
     or individuals with special expertise in providing quality 
     services to residents of skilled nursing facilities;
       (B) innovative payment techniques, including capitation 
     payments, for all or selected services provided under such 
     projects and incentive payments to reward favorable cost and 
     quality outcomes;
       (C) provision of services not normally covered under the 
     medicare program, if the provision of such services would 
     result in the more cost-effective provision of, or higher 
     quality of, services covered under such program; or
       (D) reduced cost-sharing requirements for medicare 
     beneficiaries participating in such projects.
       (c) Waiver Authority.--The Secretary may waive such 
     requirements of the medicare program as may be necessary for 
     the purposes of carrying out the demonstration projects 
     conducted under this section other than requirements relating 
     to providing medicare beneficiaries with freedom of choice of 
     provider under section 1802 of the Social Security Act (42 
     U.S.C.1395a) or any other provision of law.
       (d)  Report to Congress.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter, the 
     Secretary shall report to Congress on the demonstration 
     projects conducted under this section.

     SEC. 402. DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF 
                   PERSONS WITH SERIOUS ILLNESSES.

       (a) Expansion of Medicare Coordinated Care Demonstration 
     Project.--Section 4016 of the Balanced Budget Act (Public Law 
     105-33; 111 Stat. 343) is amended--
       (1) by striking subsection (a)(2) and inserting the 
     following:
       ``(2) Target individual defined.--In this section, the term 
     ``target individual'' means an individual that is enrolled 
     under the fee-for-service program under parts A and B of 
     title XVIII of the Social Security Act (42 U.S.C. 1395c et 
     seq.; 1395j et seq.) and--
       ``(A) has a chronic illness, as defined and identified by 
     the Secretary; or
       ``(B) has a serious illness, as so defined and 
     identified.'';
       (2) in subsection (b)(2), by striking ``Not'' and inserting 
     ``With respect to demonstration projects for items and 
     services provided to target individuals described in 
     subsection (a)(2)(A), not''; and
       (3) by adding at the end the following:
       ``(f) Requirements.--
       ``(1) In general.--The demonstration projects conducted 
     under this section shall include--
       ``(A) programs of case management;
       ``(B) programs of disease management; and
       ``(C) such other programs as the Secretary determines are 
     likely to increase the quality of, and reduce the cost of, 
     the care provided to target individuals.
       ``(2) Authorized techniques.--The demonstration projects 
     conducted under this section may include--
       ``(A) contracts with centers of excellence or other 
     entities or individuals with special expertise in providing 
     quality services to target individuals;
       ``(B) innovative payment techniques, including capitation 
     payments, for all or selected services provided under such 
     projects and incentive payments to reward favorable cost and 
     quality outcomes;
       ``(C) provision of services not normally covered under 
     title XVIII of the Social Security Act (42 U.S.C 1395 et 
     seq.), if the provision of such services would result in the 
     more cost-effective provision of, or higher quality of, 
     services covered under that title; or

[[Page S5112]]

       ``(D) reduced cost-sharing requirements for target 
     individuals participating in such projects.''.
       (b) Effective Date.--The amendments made by this section 
     shall take effect on the date of enactment of this Act.

   TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER 
                               AMERICANS

     SEC. 501. WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF 
                   OLDER AMERICANS.

       (a) In General.--Not later than December 31, 2002, the 
     President shall convene a White House Conference on Improving 
     the Health of Older Americans.
       (b) Goal of Conference.--The goal of the Conference shall 
     be to--
       (1) develop a consensus on a program to enable older 
     Americans to protect and improve their own health;
       (2) develop procedures to ensure that--
       (A) older Americans are provided with the highest standard 
     of health care available, with an emphasis on assuring that 
     standard practice is also the best practice; and
       (B) the needs of older Americans are more effectively met 
     through the benefits provided under the medicare program; and
       (3) outline a research and demonstration agenda to further 
     the goals described in paragraphs (1) and (2).
       (c) Conference Participants.--
       (1) Participants.--In order to carry out the purposes of 
     this section, the Conference shall bring together--
       (A) representatives of older Americans and those who care 
     for older Americans;
       (B) researchers and research institutions with an expertise 
     in issues related to older Americans;
       (C) health professionals and members of professional 
     societies with expertise in caring for older Americans; and
       (D) other appropriate parties.
       (2) Selection of delegates.--The participants shall be 
     selected without regard to political affiliation or past 
     partisan activity and shall, to the best of the President's 
     ability, be representative of the spectrum of thought in the 
     field of geriatric health care.
                                  ____


            Medicare Health Improvement Act of 2000--Summary

       The viability of Medicare is increasingly threatened as the 
     nation's population ages and as large numbers of 
     beneficiaries are supported by fewer workers. The current 
     debate over the future of Medicare often revolves around 
     benefit cuts or tax increases. But an alternative that should 
     be part of the debate is to improve the health of 
     beneficiaries and reduce the demand for Medicare. 
     Unfortunately, Medicare contains few incentives to encourage 
     beneficiaries and providers to take health promotion and 
     disease prevention seriously. This bill will help older 
     Americans and individuals with disabilities to improve their 
     health and will educate health care providers in the best 
     practices to achieve these goals.


                    title i: hcfa mission statement

       The purpose of this title is to establish a mission 
     statement for the Health Care Financing Administration, the 
     agency in the Department of Health and Human Services that 
     administers Medicare. The mission of HCFA would be to: (1) 
     effectively and efficiently administer health insurance 
     coverage; (2) assure that the health care provided to 
     Medicare beneficiaries is of the highest quality; (3) carry 
     out health promotion and disease prevention activities; (4) 
     and assure the highest possible level of functioning for 
     beneficiaries.


  title ii: enabling older americans and persons with disabilities to 
                          improve their health

       Cost-sharing is waived for the following preventive 
     services currently covered by Medicare--screening 
     mammography, screening pelvic exam, hepatitis B vaccine and 
     its administration, colorectal cancer screening, bone mass 
     measurement, prostate cancer screening, and diabetes 
     outpatient self-management training services.
       An information campaign for individuals over age 50 and 
     individuals with disability will be conducted jointly by the 
     Secretary of Health and Human Services and the Commissioner 
     of Social Security to promote the use of preventive health 
     services, including services not covered by Medicare. The 
     campaign will also encourage the proper use of prescription 
     and over-the-counter medications, and the use of measures 
     such as exercise, proper diet, and accident prevention to 
     safeguard health.
       A health status self-assessment program will be developed 
     to help Medicare beneficiaries identify health information, 
     risk factors, and symptoms that they should act on or discuss 
     with their health provider.


   title iii: improving the quality of care for older americans and 
                       persons with disabilities

       HHS, in consultation with other agencies, will conduct a 
     study to determine areas in the treatment of Medicare 
     beneficiaries that do not meet the highest professional 
     standards. The study will also determine the best practices 
     for treatment in these areas and inform Medicare 
     beneficiaries about the study results.
       A program will be established to inform health 
     professionals of the best practices for treatment, and to 
     reduce hospital stays and outpatient visits attributable to 
     improper use of medications.
       A task force will conduct studies to determine which 
     preventive services in primary care are most valuable to 
     older Americans.
       A smoking cessation demonstration project will determine 
     how to reduce smoking most effectively among Medicare 
     beneficiaries.


title iv: demonstration projects to improve the care of skilled nursing 
              residents and persons with serious illnesses

       HHS will conduct demonstration projects on case management 
     and disease management to increase the quality and reduce the 
     cost of care for Medicare beneficiaries in nursing 
     facilities. The projects will encourage contracts with 
     Centers of Excellence, and will be authorized to use 
     innovative payment techniques, explore services not normally 
     covered by Medicare, and experiment with reduced cost-sharing 
     requirements for beneficiaries. Similar demonstration 
     projects will be conducted to improve the care of 
     beneficiaries with serious or chronic illness who are not in 
     nursing facilities.


   title iv: white house conference on improving the health of older 
                               americans

       This title requests the President to convene a White House 
     Conference on Improving the Health of Older Americans. The 
     goals of the Conference will be to develop ways to enable 
     older Americans to improve their health, and to develop 
     procedures to ensure that they receive the highest quality of 
     care, including the development of a research and 
     demonstration agenda to advance these goals.


                                  cost

       The Congressional Budget Office estimates that the cost of 
     this program will be $1.6 billion over 5 years and $5 billion 
     over 10 years.
                                  ____


          Medicare Health Improvement Act of 2000--Fact Sheet

       The health and quality of life for millions of adults age 
     65 or older and people with disabilities have significantly 
     improved under Medicare. From 1982 to 1994, chronic 
     disability among Americans over 65 declined by 1.3% annually, 
     and has continued to decline through 1999. Nevertheless, a 
     recent report by the World Health Organization revealed that 
     the U.S. lags behind Europe, Australia, Canada, Israel and 
     Japan in ``healthy life expectancy.'' Americans have a life 
     expectancy of 76.7 years of which 70 will be without 
     disability, in comparison to Japanese citizens who can 
     anticipate 74.5 healthy years. Chronic disability robs older 
     Americans of active and productive years. It adds $26 billion 
     annually in health care costs for those over 65 who lose 
     their ability to live independently over the course of a 
     year.
       In the next 30 years, the viability of Medicare will be 
     challenged as the baby boom generation ages. The percentage 
     of the population 65 and older is expected to increase from 
     13% to 19% in 2025, resulting in larger numbers of 
     beneficiaries who will be supported by fewer workers. If the 
     prevalence of chronic disability can be further reduced and 
     healthy life expectancy increased, the aging population will 
     enjoy a longer period of independence and general well-being 
     while using fewer medical services.
       Medicare was enacted in 1965 to ensure acute medical care 
     for older adults and persons with disabilities. As the field 
     of medicine and the demographics of the American population 
     have changed, the purpose of Medicare has evolved to include 
     health promotion and disease prevention activities.
       Older Americans and persons with disabilities can 
     contribute significantly to improving their health.
       Medicare offers multiple preventive services, but current 
     cost-sharing requirements often deter people from using these 
     services. Additional measures such as exercise, proper diet, 
     accident prevention and appropriate use of medications, can 
     enable beneficiaries to prevent or delay the onset of 
     disability. According to Healthy People 2010, ``More than any 
     other age group, older adults are seeking health information 
     and are willing to make changes to maintain their health and 
     independence.'' Medicare can do more to inform people about 
     health promotion and disease prevention to help them improve 
     their health.
       Lifestyle problems account for approximately 70% of the 
     physical decline and disease that occur with aging. The over-
     65 population is increasingly knowledgeable about medical 
     issues and can be motivated to make behavioral changes to 
     improve their health.
       Deaths from heart disease and stroke rise significantly 
     over age 65, accounting for more than 40% of all deaths among 
     persons aged 65 to 74, and almost 60% of deaths in persons 
     age 85 and older. Medication and dietary changes have been 
     shown to reduce risk factors for heart disease and stroke, 
     such as high blood pressure and high cholesterol. Other 
     lifestyle changes--including increased physical activity, 
     maintaining healthy weight and cessation of smoking--can 
     also be effective.
       Osteoporosis leads to 300,000 hip fractures each year and 
     50,000 deaths from complications. 50% of fracture victims 
     lost their ability to walk independently. The direct and 
     indirect costs of osteoporosis are estimated to be $13.8 
     billion annually.
       Only 13% of people ages 65 to 74 engage in vigorous 
     physical activity that promotes cardiorespiratory fitness and 
     prevents osteoporosis. Only 11% engage in strengthening 
     exercises and only 22% engage in

[[Page S5113]]

     stretching exercises. For those ages 75 older, the rates are 
     6%, 8%, and 21% respectively. Yet these activities help older 
     adults maintain their functional independence and quality of 
     life.
       The incidence of cancer in adults ages 65 and older is 
     approximately 11 times higher than that for persons under 65. 
     Most cancers can be treated and many can be curd if detected 
     early, but cancer screening tests are underutilized by 
     Medicare beneficiaries. In 1998, only 42.7% of older women 
     obtained a Pap smear. One study showed that only 62% of 
     breast cancer survivors over 65 and at risk for recurrence, 
     obtained an annual mammogram.
       Good health largely depends on taking responsibility for 
     one's own health. Studies support a role for educational 
     programs that provide relevant information and guidelines to 
     enable medical consumers to determine when professional care 
     is required.
       Medicare beneficiaries are entitled to treatment that meets 
     the highest professional standards.
       Medicare effectively pays the bills for covered health 
     services, but it is less successful in assuring that older 
     adults and persons with disabilities actually receive the 
     quality health care they need and deserve. Less than optimal 
     health care is extremely costly to Medicare.
       Approximately 17,000 individuals aged 65 or older die of 
     influenza or influenza-related pneumonia each year. But in 
     1997, only 63% of non-institutionalized older adults received 
     the influenza vaccine, and only 43% received the pneumococcal 
     vaccine. For every 10,000 persons over 65 who receive the 
     pneumococcal vaccine, approximately $1.4 million in health 
     care costs are saved.
       On average, older adults use 4.5 prescription medication at 
     the same time and are at higher risk of misuse or drug-drug 
     interactions. Hospitalization from drug reactions or 
     interactions is six times higher for older adults than for 
     the general population.
       Aspirin is an effective therapy that can reduce the risk of 
     death and disability from coronary artery disease, including 
     heart attacks and strokes. Yet this inexpensive medication is 
     inadequately used, especially in community settings. 
     General practitioners (11%), family doctors (18%), and 
     internists (20%) are less likely to recommend the use of 
     aspirin than are cardiologists (37%). Aspirin is 
     especially underused in patients over 80 years old, even 
     though this population is likely to receive the greatest 
     benefit.
       Early use of a beta-blocker reduces the rates of mortality 
     and rehospitalization after acute myocardial infarction. Yet 
     51% of older adults who are eligible for such therapy do not 
     receive a beta blocker after a heart attack. In fact, 
     patients at highest risk for death in the hospital were the 
     least likely to receive beta blockers.
       Mental illness is not a part of normal aging. Depression 
     affects up to 20% of older adults in the community and up to 
     37% of older primary care patients, but often goes 
     unrecognized and untreated. Both major and minor depression 
     are associated with high use of health care services and poor 
     quality of life. Untreated, depression can worsen symptoms of 
     other illness, produce disability, and result in suicide. The 
     incidence of suicide is highest in the elderly population. Up 
     to 75% of older suicide victims are seen by their primary 
     care provider in the month prior to suicide, but are not 
     treated or referred for treatment of their depression.
       Physicians diagnose only 30% of older adults who have an 
     alcohol problem. The effects of alcohol can be greater in 
     older patients, due to changes in body mass and metabolism. 
     Drinking is linked with falls, motor vehicle accidents, and 
     is often a factor in suicide and martial violence. Alcohol 
     interacts with may medications and impairs judgment and 
     cognition. The long-term abuse of alcohol increases the risk 
     for high blood pressure, arrhythmias, cardiomyopathy and 
     stroke, as well as certain cancers.
       Smoking-related expenditures were 9.4% of Medicare 
     expenditures in 1993 and were estimated to cost Medicare 
     $20.5 billion in 1997. Cessation of smoking slows the rate of 
     decline of lung function, in addition to reducing the risk of 
     heart disease and stroke.
       Improving the health of older adults and persons with 
     disabilities will also improve the health of Medicare.
       Improving the health of older adults and persons with 
     disabilities is essential for its own sake, and is also one 
     of the most important ways to improve the health of Medicare, 
     even as enrollment increases.
       Chronically disabled adults over 65 have health costs that 
     are seven times those of healthy individuals. Reduction in 
     the rate of chronic disability could maintain the current 
     disabled retiree to worker ratio through 2030, despite a 
     dramatic change in the overall retiree to worker ratio, with 
     potentially immense savings to Medicare.
       Savings achieved by improving the health of Medicare 
     beneficiaries outweigh any costs associated with increased 
     longevity.


                                summary

       Establishes a mission statement for the Health Care 
     Financing Administration, with new emphasis on health 
     promotion and diseases prevention.
       Waives cost-sharing for preventive services currently 
     offered by Medicare, such as screening mammography, screening 
     pelvic exam, colorectal screening, bone mass measurement and 
     diabetes self-management training.
       Provides an information campaign to promote the use of 
     preventive health services.
       Authorizes the development of a health self-assessment tool 
     that includes assessment of mental health.
       Promotes the use of best practices for treatment of 
     Medicare beneficiaries.
       Establishes a demonstration project for smoking cessation.
       Provides demonstration projects to improve the care of 
     residents in skilled nursing facilities and persons with 
     serious illnesses who are not in nursing facilities.
       Requests a White House conference on improving the health 
     of older Americans.
       The cost of these specific measures is estimated to be $1.6 
     billion over 5 years and $5 billion over 10 years, but these 
     costs are likely to be offset by reductions in Medicare costs 
     as the measures become effective in improving the health of 
     senior citizens.
                                 ______